Summary

Impact of LHB tenodesis on postoperative outcome after rotator cuff reconstruction

Abstract

Background

The role of the long head of the biceps tendon (LHB) as a pain-causing concomitant pathology of rotator cuff rupture is well known. Tenodesis of the LHB is frequently performed in rotator cuff reconstruction. However, it remains unclear to what extent tenodesis of LHB influences the clinical and radiologic outcome of rotator cuff repair.

Questions/purposes: (1) Does tenodesis of the LHB affect the clinical outcome after rotator cuff repair? (2) Does tenodesis of the LHB affect the rate of rotator cuff healing or re-rupture after repair?

Methods

Included were 63 patients treated for rotator cuff tears in our department between August 2012 and December 2014. Depending on the LHB surgery performed, patients were divided into two different groups: one group included patients who received rotator cuff reconstruction with tenodesis of the LHB and one without tenodesis. In all included patients, follow-up took place 2.28±0.37 years postoperatively. All patients were asked to complete the WORC, ASES, Constant and Oxford scores. Patients underwent a clinical examination including range of motion and force measurements. Moreover, all patients received an MRI scan of the operated shoulder. Integrity and quality of the rotator cuff on postoperative MRI were analyzed by the two blinded observers using Sugaya and Castricini classifications. To answer the first question of the study, clinical results were compared between both groups. To answer the second question of the study integrity and quality on the MRI of the rotator cuff were correlated between the two groups. To assess interobserver reliability, two observers took measurements in a blinded fashion. Their experience was equivalent to that of orthopedic residents, and they completed a training protocol before taking the measurements.

Results

All analysed clinical scores showed no difference between patients that received a tenodesis and those without tenodesis: Worc (98.15 ± 2.00 against 97.29 ± 2.56; difference = 0.86 (-0.43–2.16); p = 0.186); Constant (70.44 ± 18.10 against 71.99 ± 14.04; difference = 1.54 (-7.56–10.65); p = 0.735); Oxford (25.34 ± 12.61 against 24.76 ± 13.65; difference = 0.58 (-6.80–7.97); p = 0.874); ASES (78.39 ± 21.09 against 84.91 ± 16.28; difference = 6.51 (-4.07–17.10); p = 0.222). Moreover, no difference was found between both groups in terms of range of motion and force in different starting positions; With exception of the fatty infiltration (0° = 21/26 (80.8%) against 17/25 (68.0%); 1° = 4/26 (15.4%) against 7/25 (28.0); 2° = 1/26 (3.8%) against 1/25 (4.0%); 3°: 0/26 (0%) against 1/25 (4.0%); p = 0.109), no difference was found between the tenodesis and no tenodesis groups concerning integrity and quality of the rotator cuff: re-rupture (7/26 (26.9%) against 5/25 (20.0%); p = 0.399); tendon thickness (1° = 6/26 (23.1%) against 9/25 (36.0); 2° = 9/26 (34.6%) against 11/25 (44.0%); 3°: 11/26 (42.3%) against 6/25 (24.0%); p = 0.109); footprint coverage (1° = 3/26 (11.5%) against 6/25 (24.0%); 2° = 2/26 (7.7%) against 5/25 (20.0%); 21/26 (80.8%) against 15/25 (60.0%); p = 0.069); tendon quality (1° = 5/26 (19.2%) against 8/25 (32.0%); 2° = 4/26 (15.4%) against 8/25 (32.0%); 17/26 (65.4%) against 10/25 (40.0%); p = 0.060), muscle atrophy (1° = 24/26 (92.2%) against 16/25 (64.0%); 2° = 2/26 (7.7%) against 10/25 (40.0%); 3°: 0/26 (0.0%) against 0/25 (0.0%); p = 0.180). All measurements had excellent intrarater (Cronbach´s alpha =, CI 95%; p >) and interrater (interrater correlation coefficient =, CI 95%; p >) reliabilities.

Conclusions

Regarding the first study question, the results of the present study showed that concomitant tenodesis of the LHB have no impact on clinical outcome after rotator cuff repair. Regarding the second question of the study, our results suggest that concomitant tenodesis of the LHB, with exception of the fatty infiltration, do not influence radiological integrity and quality of the repaired rotor cuff. Therefore, simultaneous tenodesis of the LHB appears to be a safe and effective procedure that does not further worsen postoperative outcomes after rotator cuff reconstruction.